Upper endoscopy with biopsy
Facility: Fredonia Regional Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $929
- Cash Discount Price: $1,360
- vs. Medicare Baseline: 1.00x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $926.63 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $152 - $1,153 | 16% |
| Veterans Programs - All Plans | $152 - $929 | 16% |
| Aetna | $459 - $1,639 | 50% |
| UnitedHealthcare | $810 - $1,639 | 87% |
| Reserve National-All Plans | $810 - $1,639 | 87% |
| Meritain-All Plans | $810 - $1,639 | 87% |
| Cigna | $810 - $1,639 | 87% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Fredonia Regional Hospital in Fredonia, KS, the cash price is $1,360.00, which matches the facility's cash median. While the hospital is a Critical Access Hospital owned by the local government, the negotiated rates vary significantly by insurer, ranging from $152 to $1,639 across seven payers. Notably, the median negotiated rate of $929.00 is lower than the cash price, meaning patients with high-deductible plans might save money by paying cash upfront rather than relying on insurance, provided they qualify for the cash rate. However, because the hospital is in-network for most major carriers, patients should verify their specific plan's deductible status before scheduling, as they may still be responsible for out-of-pocket costs if their deductible has not been met.
To ensure you receive the most accurate pricing, it is important to distinguish between the hospital's gross charges and the actual amounts billed to your insurance. The Medicare benchmark for this service is $926.63, which serves as a reliable baseline for evaluating the facility's pricing structure rather than the inflated chargemaster list. While the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, you should still request a detailed, itemized bill to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Finally, if you are self-pay, ask the billing department about prompt-pay discounts, which can reduce the $1,360.00 cash price by 20% to 50% if settled within 30 days